Medicare Advantage Industry Segment-Specific Compliance Program Guidance

The Office of Inspector General (OIG) released a publication entitled, Medicare Advantage Industry Segment-Specific Compliance Program Guidance, February 2026.

It describes risk areas in the Medicare Advantage Organization (MAO) program, recommendations to mitigate those risks and information to consider in compliance programs.

For risk adjustment, take a look at Section II. Compliance Risk Areas and Recommendations for Mitigation, section C. Risk Adjustment

OIG has examined MAOs reporting diagnoses based solely on chart reviews or health risk assessments (HRAs) and providing no other records in the encounter data that enrollees received services for the diagnoses.

"These resources are not one-size-fits-all, comprehensive, or inclusive of all compliance considerations or risks. They are not binding on any individual or entity. Of note, OIG uses the word “should” in the Medicare Advantage ICPG and GCPG to present voluntary, nonbinding guidance. This means that the documents do not create any new obligations or standards for any individual or entity." p1 of the guidance

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